Expert: Ivan Goldberg, M.D. - 11/15/2009

Question
how serious is this diagnosis? crazy? paranoid?
I am seeing someone who has been diagnosed and is taking medication for bipolar.  She doesn't like the diagnosis.  She thinks it is wrong and has a fear of counselors and people in that profession.  She doesn't think we have had sex yet because we have not had intercourse.  I think we have had sex but I think intercourse is a giant step in intimacy. I don't want intercourse until I know her well enough to know if intercourse is 'good' for her. The doctor prescribing meds isn't the one who diagnosed her.  He told her she didn't need counseling! I would think that anyone with a diagnosis like that should have ongoing counseling.  I ma shocked that a psychiatrist would say that.  Is there no talk therapy that is effective for bipolar people?  I was under the impression that you got better results with both approaches.  I would also think that if the patient agreed wtih the daignosis through counseling that it would be better for all parties.  What am I getting into when it comes to dealing with someone who is bipolar?  I heard they can flip on you.  (Get a fear about you and think you are their enemy.)  She seems to be a different person at times when it comes to conversations like she can't remember what she said before or maybe she is just trying to win her point.  She doesn't think that she pressured me to go as far as we have sexually almost as if she dosen't rember or is in denial.  (We have done everything but intercourse. Having orgasms through; mutual masturbation, oral sex, and petting.  We do  sleep together when we are spending the night together.)  How serious is bipolar as far as a diagnosis?  Is it a  major or minor mental problem?

Answer
Hi . . .

There are many diagnoses in the bipolar spectrum and some are very serious and other much less so.

It is my belief, and the belief of the majority of psychiatrists, that people early in their treatment for bipolar disorder should be treated with both medication and psychotherapy.

While people with bipolar disorder can have mood swings, it is unlikely that they will "flip" in response to a specific stimulus.

As I indicated above some forms of bipolar disorder are very serious and others are not.

Best regards . . .

Ivan
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